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PROPRIUM PHARMACY
RWI23704B Urban League of Hampton Roads
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Covered Entity Details
Entity Name
Urban League of Hampton Roads
Subdivision Name
Main Office
Type
Ryan White Part A
340B ID
RWI23704B
Entity Address
7300 Newport Ave
500
Norfolk, VA 23505
Grant Number
H89HA00053
Participating Start Date
1/1/2019
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PKWY STE 400
CHESAPEAKE, VA 23320-5176
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen L Williams, Medical Case Manager
(757) 627-0864
Contract Pharmacy Representative
Sentara Enterprises
Jim R Schwamburger, Director
(757) 553-3211
Signed By Date
4/15/2019
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